Epoetin alfa improves survival after chemoradiation for Stage III esophageal cancer: Final results of a prospective observational study

Rades, Dirk; Tribius, Silke; Yekebas, Emre F.; Bahrehmand, Roia; Wildfang, I.; Kilic, Ergin; Muellerleile, Ulrich; Gross, E.; Schild, Steven E.; Alberti, W.

doi:10.1016/j.ijrobp.2005.12.019

Cited by 25 publications

(20 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At present, preoperative iron therapy is recommended for iron-deficiency anemia [17]. There is limited evidence in patients undergoing esophagectomy that erythropoietin (EPO; with or without iron) during neoadjuvant therapy increases hemoglobin and possible survival [73,74]. However, the lack of follow-up, lack of high-level evidence, and concerns regarding disease control indicate the need for further research and preclude recommendation.…”

Section: Potential Novel Pre-optimization Targetsmentioning

confidence: 99%

Nutrition in peri-operative esophageal cancer management

Steenhagen

Vulpen

Hillegersberg

et al. 2017

Expert Review of Gastroenterology & Hepatology

View full text Add to dashboard Cite

Introduction: Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, perioperative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to longterm nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.ARTICLE HISTORY

show abstract

Section: Potential Novel Pre-optimization Targetsmentioning

confidence: 99%

Nutrition in peri-operative esophageal cancer management

Steenhagen

Vulpen

Hillegersberg

et al. 2017

Expert Review of Gastroenterology & Hepatology

View full text Add to dashboard Cite

show abstract

“…No patient treated for 6 weeks had three hemoglobin levels < 12 g/dl and three levels ≥ 12 g/dl. The patients receiving erythropoietin were part of a prospective observational phase IV study, which had been approved by the local ethics committee [14]. The patients had given informed consent.…”

Section: Erythropoietinmentioning

confidence: 99%

Impact of VEGF and VEGF Receptor 1 (FLT1) Expression on the Prognosis of Stage III Esophageal Cancer Patients after Radiochemotherapy*

et al. 2008

Self Cite

View full text Add to dashboard Cite

show abstract

“…Th ese results favouring epoetin alfa may be explained by the fact that in this trial, the epoetin alfa dose was reduced to 33% when the haemoglobin level reached 13 g/dl, and discontinued at 14 g/dl. A benefi t on treatment outcome with epoetin alfa was also observed in a prospective observational study of 96 patients receiving chemoradiation for oesophageal cancer [19]. In that study, epoetin alfa was started at haemoglobin levels <13 g/dl and stopped at 14 g/dl.…”

Section: Erythropoietin Stimulating Agents (Esas)mentioning

confidence: 69%

Challenges of anemia correction during radiotherapy and chemoradiation

Rades

Schild

2012

memo

View full text Add to dashboard Cite

Th e eff ect of radiotherapy depends on optimal tumour oxygenation, as tumour hypoxia impairs the production of radiation-induced cytotoxic free radicals resulting in less tumour cell kill. Th e range of haemoglobin levels optimal for tumour oxygenation is 12-14 g/dl in women and 13-15 g/dl in men. It appears reasonable to elevate the haemoglobin level in anaemic cancer patients into this optimal range. Th is may be achieved with red blood cell transfusions (RBCT) or erythropoiesis stimulating agents (ESAs). However, RBCT have had negligible or even negative eff ect on patient outcome, possibly because RBCT induce immunosuppression or result in haemoglobin levels too high for optimal tumour oxygenation. Several randomized trials have demonstrated that patients irradiated for head-and-neck cancer had worse outcomes with ESAs than the control group. However, in the majority of these trials, over-treatment with ESAs resulted in haemoglobin levels above the optimal range. Tumour oxygenation is impaired by inappropriately high haemoglobin levels due to increased blood viscosity and decreased tumour cell perfusion. Th is concept is supported by the fi ndings of prospective studies in cervix cancer and esophageal cancer patients. In these studies the ESA administration was withheld at a haemoglobin level of 14 g/dl resulting in a positive eff ect of ESAs on treatment outcome. In summary, the eff ect of RBCT and particularly of ESAs during radiotherapy remains unclear. Further randomized trials are required. Until such trials are available, one should follow the ASCO and ESMO guidelines that are very conservative regarding the administration of ESAs during radiotherapy and chemoradiation.

show abstract

Epoetin alfa improves survival after chemoradiation for Stage III esophageal cancer: Final results of a prospective observational study

Cited by 25 publications

References 35 publications

Nutrition in peri-operative esophageal cancer management

Nutrition in peri-operative esophageal cancer management

Impact of VEGF and VEGF Receptor 1 (FLT1) Expression on the Prognosis of Stage III Esophageal Cancer Patients after Radiochemotherapy*

Challenges of anemia correction during radiotherapy and chemoradiation

Contact Info

Product

Resources

About